Patterns of ischaemia and reperfusion in nipple-sparing mastectomy reconstruction with indocyanine green angiography

Nguyen, Chu Luan; Tam, Sze Ki Melanie; Easwaralingam, Neshanth; Seah, Jue Li; Comerford, Alexander Peter; Yu, Ann Chen Xi; Mak, Cindy; Pulitanò, Carlo; Warrier, Sanjay

doi:10.1016/j.bjps.2022.08.006

Cited by 4 publications

(6 citation statements)

References 24 publications

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“…IBR proceeded if perfusion was deemed sufficient. If the flap demonstrated poor perfusion patterns by visual NIR interpretation and an absolute fluorescence intensity of less than 14 units 13 , the wound was closed without attempting reconstruction. Drains were routinely inserted.…”

Section: Methodsmentioning

confidence: 99%

“… 10 , 11 A recent study also investigated its routine use in selecting patients who may benefit from a temporary delay in performing reconstruction (termed staged immediate breast reconstruction, SIBR) by measuring fluorescence intensity from still images 11 in decision-making albeit with modest sensitivity and specificity regarding complication prediction (62.5% and 69.5%, respectively). 12 , 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

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A feasibility study assessing quantitative indocyanine green angiographic predictors of reconstructive complications following nipple-sparing mastectomy

Dalli,

Nguyen,

Jindal

et al. 2024

JPRAS Open

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A feasibility study assessing quantitative indocyanine green angiographic predictors of reconstructive complications following nipple-sparing mastectomy

Dalli,

Nguyen,

Jindal

et al. 2024

JPRAS Open

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“…Immediate reconstructions are understood to be associated with a higher degree of vascular stress and tension on mastectomy skin flaps, which is further compounded by the inability to induce neovascularization to the NAC [40]. The authors have shown that it is possible to identify patients intraoperatively with ischemia of the mastectomy skin flap immediately following NSM based on ICG angiography analysis [12]. The reconstruction surgery for these patients was subsequently delayed after a median of seven days.…”

Section: Indocyanine Green Angiogram Patterns Of Ischemia and Reperfu...mentioning

confidence: 99%

“…The delayed reconstruction alone, without any other intraoperative intervention, was sufficient to allow reperfusion of the ischemic flaps. The improvement in perfusion was identified on both the fluorescence angiograms and when perfusion units were applied to the skin flaps and NAC using the integrated software (Figure 1) [12].…”

Section: Indocyanine Green Angiogram Patterns Of Ischemia and Reperfu...mentioning

confidence: 99%

“…ICG fluorescence is a versatile technology within breast cancer and reconstruction surgery. It can be used to evaluate mastectomy skin flap perfusion during breast reconstruction and to map lymphatics to assist with sentinel lymph node (SLN) biopsy for early breast cancer [11][12][13][14][15]. This narrative review examines the evolution of ICG fluorescence in breast and axilla surgery from an Australasian perspective.…”

Section: Introductionmentioning

confidence: 99%

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Evolution of Indocyanine Green Fluorescence in Breast and Axilla Surgery: An Australasian Experience

Nguyen,

Dayaratna,

Graham

et al. 2024

Life

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The evolution of indocyanine green (ICG) fluorescence in breast and axilla surgery from an Australasian perspective is discussed in this narrative review with a focus on breast cancer and reconstruction surgery. The authors have nearly a decade of experience with ICG in a high-volume institution, which has resulted in publications and ongoing future research evaluating its use for predicting mastectomy skin flap perfusion for reconstruction, lymphatic mapping for sentinel lymph node (SLN) biopsy, and axillary reverse mapping (ARM) for prevention of lymphoedema. In the authors’ experience, routine use of ICG angiography during breast reconstruction postmastectomy was demonstrated to be cost-effective for the reduction of ischemic complications in the Australian setting. A novel tracer combination, ICG–technetium-99m offered a safe and effective substitute to the “gold standard” dual tracer for SLN biopsy, although greater costs were associated with ICG. An ongoing trial will evaluate ARM node identification using ICG fluorescence during axillary lymph node dissection and potential predictive factors of ARM node involvement. These data add to the growing literature on ICG and allow future research to build on this to improve understanding of the potential benefits of fluorescence-guided surgery in breast cancer and reconstruction surgery.

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Role of Qualitative and Quantitative Indocyanine Green Angiography to Assess Mastectomy Skin Flaps Perfusion: A Prospective Monocentric Experience

Mastronardi,

Fracon,

Scomersi

et al. 2024

Surg Innov

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Introduction Mastectomy skin flap (MSF) necrosis remains a significant complication in breast reconstruction. This study aims to identify a correlation between the qualitative and quantitative analysis of the MSF perfusion grade and the skin necrosis rate 1 month after surgery using indocyanine green angiography (ICGA), focusing on lag time and perfusion metrics. Methods Consecutive women scheduled for nipple/skin-sparing/skin-reducing mastectomy between May 2020 and October 2022 were prospectively enrolled. Patients were divided into Group 1 in the absence of superficial and full-thickness necrosis (SN; FTN) and Group 2 in the presence of both. Demographic data, lag time T1 (time between ICG injection and the initial perfusion of the least perfused MSF area), ICG-Q1, and ICG-Q% (absolute and relative perfusion values of the least vascularized area) were collected. Results 76 breasts were considered. FTN was reported in 8 breasts (10.5%) and SN in 4 (5.2%). The 2 groups statistically differ in T1 (Group2 > Group1), ICG-Q1, and ICG-Q% (Group1 > Group2) ( P < 0.05). T1 longer than 170 seconds, body mass index, previous chemo/radiotherapy, arterial hypertension, breast weight, type of surgery, and ICG quantitative values can help in predicting MSF necrosis. Conclusions MSF qualitative and quantitative perfusion evaluation can be helpful to prevent MSF necrosis. However, it should be considered together with the patient’s characteristics, the type of surgery, and T1. In this way, it is possible to predict the risk of MSF necrosis and plan the best reconstructive strategy.

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Patterns of ischaemia and reperfusion in nipple-sparing mastectomy reconstruction with indocyanine green angiography

Cited by 4 publications

References 24 publications

A feasibility study assessing quantitative indocyanine green angiographic predictors of reconstructive complications following nipple-sparing mastectomy

A feasibility study assessing quantitative indocyanine green angiographic predictors of reconstructive complications following nipple-sparing mastectomy

Evolution of Indocyanine Green Fluorescence in Breast and Axilla Surgery: An Australasian Experience

Role of Qualitative and Quantitative Indocyanine Green Angiography to Assess Mastectomy Skin Flaps Perfusion: A Prospective Monocentric Experience

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